Column | Jan. 7

Fixing ObamaCare (Yes, We Can)

As the confetti settled in Times Square, the New Year rang in with the first wave of new insurance policies under the Affordable Care Act, widely known as “ObamaCare.” The White House reported that more than 2.1 million Americans have already signed up for private insurance through the ObamaCare exchanges. Though the Affordable Care Act is a huge leap toward improving the future of health care access for Americans, ObamaCare does come with its share of problems. However, when the United States is an outlier on the map of developed countries that all have some form of universal health care, and Americans spend more per person on health care than citizens of countries with universal health care, the solution is to steadily smooth out the rough spots of a new legislation and fix its problems. With Republicans clamoring for its repeal, the government shutting down over the dispute, and over two dozen states refusing to opt in to ObamaCare’s Medicaid expansion, the answer is still not to get rid of ObamaCare.

Unfortunately, one of the immediate results of ObamaCare was the cancellation of insurance coverage for 4.7 million Americans whose skimpy and lower-cost plans did not meet the ACA’s strict standards. As the cancellations became a target for opponents in November 2013, the President announced insurance carriers could extend for one-year plans that would have been cancelled, and people whose plans have been cancelled will not be subject to the tax penalty for not having insurance.

Someone, somewhere, must foot the bill for extending affordable health care to everyone and that someone must be the demographic of young, healthy people. The laws of economics rule that unless there are young healthy people paying for the sicker Americans, ObamaCare cannot be sustained for very long. When sick people have insurance, the insurance companies cover medical expenses. If healthy young people buy insurance, yet do not incur medical expenses that insurance has to pay for, then insurance companies gain. Thus, the healthy people who pay for insurance balance out the payments insurance has to make to sick people. The people who eagerly signed up for ObamaCare insurance first were the ones who had preexisting conditions and were previously denied coverage or could not afford the extraordinarily high prices. In 2012, there were 18 million uninsured 19-34 year olds, according to the U.S. Census Bureau, and it was reported that this demographic accounted for “40 percent of the uninsured population under the age of 65.” If ObamaCare is to survive and not raise the deficit, as President Obama promised, then young, healthy people must buy insurance to balance out the payments insurance must make for sick people’s expenses. Currently, under the ACA, an individual who does not have insurance by March 31, 2014, will be fined $95 a year or 1 percent of their gross income, whichever is higher. This penalty will get more healthy, young people to balance out the insurance payments of older and sick Americans.

While tackling ObamaCare’s problem of costs is essential to moving forward in improving access to health care in the United States, we also have to step outside the box for a minute and consider our health care system as a whole. On Fox News, former Gov. Mike Huckabee criticized ObamaCare for only addressing insurance coverage, and not health care itself and the costs of health care, which are “out of control.” Statistics show that 75 percent of the medical expenses incurred throughout a person’s life are from the last two years of life; as Governor Huckabee says, “We don’t run to the finish line. We don’t walk to the finish line. We basically are drugged to the finish line.” This attitude, resulting from the high availability of medical procedures — albeit at high costs — toward the end of life, is that if you can fix it in the surgery room, then fix it. In the rush to administer countless drugs and procedures, expenses pile up to the sky. Some of these procedures may even be unnecessary, if a person nearing the end of life desires nothing but to go peacefully without undergoing a series of superfluous procedures. Seventy-five percent of medical expenses are incurred in the last two years of the life, and 80 percent of health care costs in the United States are for chronic diseases. Instead of spending so much money on last minute treatment, the focus should be on action taken to prevent chronic diseases. The three easily targeted causes of chronic disease are obesity, lack of exercise and smoking. The Affordable Care Act is the first step towards picking up America’s lagging access to health care. But, in order to catch up to other developed nations’ in terms of health care, the current problems of the ACA must be addressed, and eventually the law should extend to encompass the health care system itself, by tackling the sky-high costs and improving its efficiency.

Katherine Zhao is a freshman from East Brunswick, N.J. She can be reached at kz2@princeton.edu.